Tracheal rupture: Airway catastrophe associated with intubation (original) (raw)
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An unusual complication of emergency tracheal intubation
Anaesthesia, 1997
Failed spinal anaesthesia for left total hip arthroplasty was followed postoperatively by dense motor paralysis and sensory deficit in the right leg. The patient had received a dose of subcutaneous heparin 1 h before the spinal anaesthetic was attempted. She died of pulmonary embolism on the ninth postoperative day. At autopsy extensive haematomyelia was found in relation to the needle track.
The Journal of Emergency Medicine, 2013
Dr. Liza Gonen: This is the case of an 80-year-old woman who presented to the Emergency Department (ED) with respiratory distress. The patient had a 112 pack-year smoking history but endorsed no medical problems and had not sought medical care for the past 20 years. She woke up that morning acutely short of breath and walked out onto her front stoop to ''get some air'' when concerned neighbors noticed her struggling to breathe and called 911. On arrival to the ED, the patient was afebrile, heart rate 92 beats/min, blood pressure 220/100 mm Hg, respiratory rate 30 breaths/ min, and oxygen saturation 84% on room air, improved to 98% on continuous positive airway pressure (CPAP) ventilation. Head, ears, eyes, nose, and throat examination revealed equal and reactive pupils. The cardiac examination showed a regular tachycardia with no murmurs noted. There were crackles throughout bilateral lung fields and bilateral lower extremity edema. The abdomen was soft and non-tender, without palpable mass. Extremities were soft, without edema or tenderness. Neurological examination revealed normal strength and sensation of all extremities.
A Case of Recurrent Subcutaneous Emphysema as a Complication of Endotracheal Intubation
Ear, Nose & Throat Journal, 2004
Wedescribe a case ofs ubcutaneous cervicofacial emphysema in a 2 1-year-old man who had underg one endotracheal intubation while under ge neral anesthesia 2 months earlie t: The emphyseina had arisen on the right side ofthe f ace and neck and extended to the right shoulder and the cubital fossa. The pa tient was hosp italized and treated with parenteral antibiotics and hyperbaric oxygen. On hosp ital day 10, he had improved sufficiently to warrant discharg e on the next day. Two months latet; the patient p resented at a fo llow-up visit with a recurrence, and he was readm itted. By hospit al day 28, his condition had improved and he was scheduled for discharge. Ho wevet; he experienced another recurrence j ust bef ore he was to leave the hospital. The circumstances ofthis seco nd recurrence led us to suspec t that the patient was abl e to produce these signs and symp toms on his own. He was ref erredf or psy chiatric evaluation, and findings were nega tive. He was then sen t to the Ear; Nose , and Throat Service, where we corfirmed that his subcutan eous emphysetna could be brought on by Valsalva stnaneuvet: Weperformedsuspension laryn goscopy and detected two orifices of fi stular tracts next to the right vallecula and three at the root of the epiglottis. We repaired the injured mucosa and the orifices of thejistulae with absorbable sutures and cauterized the area. The swe lling resolved comp letely within 4 days, and fi ndings on a radiograph ic examination of the ches t and neck 1 week later were normal. The patient was
Unexpected difficult intubation: A case report
Trends in Anaesthesia and Critical Care, 2018
Background and goal of the study: We report of a case of unexpected difficult intubation despite preoperative evaluation. Ă Methods: A 67 years male patient scheduled for laparoscopic prostatectomy went for preoperative evaluation with the following findings: moderate obesity (BMI32), adequate mouth opening and thyromental distance, Mallampati III, history of snoring. In perspective of difficult mask ventilation he was requested to remove beard. Results: After routine monitoring and anesthesia induction, with NMBA administration following ventilability check, a first laryngoscopy revealed a Cormack-Lehane grade 3 view with limited room for airway instrumentation. After one failed conventional laryngoscopy two attempts with Airtraq (Prodol, Spain) failed because of view of sole epiglottis. Ventilation remained satisfactory thorough attempts, and a #4 LMA-fastrach (Teleflex, Ireland) was positioned resulting in poor ventilation and no view of laryngeal inlet with fiberoptic bronchoscope. Patient was then reverted to spontaneous breathing (atropine+neostigmine) and a spontaneous breathing fiberoptic intubation with a reinforced 6.5 mm OD endotracheal tube was successful, using the spray-as-you-go technique for airway topicalization. Surgery was performed and the patient received a protected extubation over airway catheter Conclusions: Our case highlights importance of ventilation over intubation, importance of preoperative evaluation (the patient, deferred to pneumologist, was diagnosed severe OSAS), possibility of failure of videolaryngoscopy, importance of avoidance of fixation error and fundamental role of fiberoptic, with spontaneous breathing, for difficult airway management. References
A Case of Death Caused by Tracheal Tube Aspiration
Anesthesiology and Pain Medicine, 2014
Introduction: Airway management, especially outside the operating room, needs meticulous observation in order to avoid certain risks, such as; endotracheal tube (ETT) disloca tion, esophageal intubation, and unwanted extubation. ETT or tracheostomy dislocation is responsible for one-half of death or brain damage cases in the ICU. Despite appropri ate fixation of an ETT, the previously mentioned compli cations can still occur. A broken ETT and consequent airway obstruction may lead to lethal complications. Case Presentation: We report a case of death caused by tracheal tube aspiration, where it was located distal to the vocal cords, with a part of it entering the right bronchus and the mediastinum, after tearing the right bronchus. Discussion: The vigilance and experience of medical personnel in the ICU, appropriate IV sedation, and using a bite block are the best ways to prevent mortality caused by aspiration of an ETT in all intubated patients.